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CASE STUDY USING BEST PRACTICE DESIGN PRINCIPLES FOR WORKSITE WELLNESS PROGRAMS

Hoffman, Lisa M.S., ACSM NPAS; Kennedy-Armbruster, Carol Ph.D., ACSM HFS

ACSM's Health & Fitness Journal: May/June 2015 - Volume 19 - Issue 3 - p 30–35
doi: 10.1249/FIT.0000000000000125
FEATURES
LEARNING OBJECTIVES 
  • 1. Apply the IAWHP Best Practice Design Principles for Worksite Health and Wellness Programs to a case study.
  • 2. Use the nine best practice dimensions outlined in a previous issue of ACSM’s Health & Fitness Journal®.
  • 3. Provide lessons learned using evidence-based models of how to best approach integrating physical activity into worksite wellness.

Lisa Hoffman, M.S., ACSM NPAS, physical activity in public health specialist, is the Healthy Change Fund coordinator for Healthy IU, Indiana University’s Employee Wellness Program. She has a master’s degree in Kinesiology from the School of Public Health at Indiana University, with a concentration in physical activity, fitness, and wellness. She is a U.S. Air Force veteran and a professional organizer.

Carol Kennedy-Armbruster, Ph.D., ACSM HFS, is a senior lecturer in the Department of Kinesiology at Indiana University. She has worked in the academic and private setting as an educator, program director, and practitioner of fitness and wellness programs for more than 30 years. Her research is centered on translational research in a worksite setting. She has a special interest in functional movement for health and evaluating physical activity/exercise program outcomes. She also is on the editorial board for ACSM’s Health & Fitness Journal®.

Disclosure: The authors declare no conflict of interest and do not have any financial disclosures.

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INTRODUCTION

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Worksite wellness programs recently have come under scrutiny for their effectiveness (6). It seems as if there is a plethora of worksite wellness programming/practices, but our overall delivery effectiveness is questionable. This case study will follow the nine steps outlined by Pronk (7) regarding “best practices of worksite health and wellness” and review a worksite wellness case study in action. Pronk (8) encourages the use of “stories” combined with data to help us better understand best practice models. The purpose of this case study is to follow the implementation of the physical activity portion of a worksite wellness initiative to shed light on the utilization of best practices.

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WHY FOLLOW A BEST PRACTICE DESIGN?

In 2010, a large Midwestern university began an employee health engagement program, in part, to reduce health care costs. The University asked employees to complete online health risk assessments. A backlash from employees caused the university to cancel the questionnaire and destroy any data already gathered (11). This university learned a valuable lesson: using a “stick” versus a carrot may not get the “buy-in” needed by employees.

The introduction of the Patient Protection and Accountability Care Act (10) emphasizes the potential role of worksite health promotion, which has placed focus on wellness resource investment. The university above was attempting to put into place a plan that helped manage this new focus. However, its lack of transparency about a sensitive issue (personal health care) was underestimated by the administration. In 2012, the university took a different approach and hired a health engagement director who used a “grassroots” approach combined with administrative support and funding to improve “human capital” with a vision of helping employees live their best lives.

It was apparent that the methods initially used did not build consensus, get employee buy-in, nor have a strategic plan regarding delivery. What follows below is a case study of the university’s recovery from this dilemma outlined using the nine best practices recommended by Pronk (7).

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NINE BEST PRACTICE DIMENSIONS

This is the story of how a large Midwestern university “reinvented” its worksite wellness program delivery model compared with the “best practice” process outlined by Pronk (7). The university started with voluntary incentivized health screens. In year 2, long-term behavior change programs (i.e., diabetes prevention program, mindful way to stress reduction, and nutritional counseling) were added. In year 3, a Healthy Change Fund was created for each department to use to implement programs and services to reach employees at all levels. What follows below is an overview of the changes made that are resulting in program/culture changes and buy-in from the constituents.

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  • 1. Leadership — Elements that set the vision for the program, assign accountability, ensure structural support for the program, engage leaders throughout the organization, set appropriate organizational policy to support health, and support the program’s need for resources.

A health engagement director was hired to redirect the wellness initiative after the initial attempt was not well received by employees (11). The director had years of experience delivering wellness to a campus community. The leadership had her report to the chief financial officer (CFO) of the university, not buried within the benefits office. With top-level support, the director took a grassroots approach and worked the trenches for the first few years. The director also created a campus wellness coalition open to all. The coalition of volunteers was composed of constituents within the university (faculty, staff, and service delivery personnel). The group met monthly and helped guide the direction of the initiative.

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Personal Story/Data

The success of the program started by impacting the “impactors” in the very early stages of the program planning before rollout. The CFO actively participated and provided feedback for the initial physical activity program, one component of the overall wellness initiative. During his 3 months of participation, the CFO lost 15 lbs and became a vocal champion for the program. His replacement (already a physical activity enthusiast personally) took the entire program to the next level and encouraged a strategic planning process through creating a system-wide wellness committee (5), encompassing multiple campuses. The results of the initial 3-year university-wide initiative were shared with the board of trustees (http://www.iu.edu/~welliu/images/Healthy%20IU.pdf).

  • 2. Relevance — Elements that address factors critical to participation and engagement of employees and their families in the various program options.

A workplace health and wellness survey of the entire campus system was administered by faculty within the university. This survey encompassed questions from the Behavioral Risk Factor Surveillance System (BRFSS) (2), the world’s largest ongoing health survey administered through the U.S. Centers for Disease Control. The survey was anonymous and administered by an academic entity and run through the institutional review board process of the campus. Results for the survey were distributed to the wellness committees and stakeholders and made public via a Web site (4). Results showed that 87% of employees on all campuses cited physical activity as a priority for program development.

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Personal Story/Data

Interesting findings fromthe workplace health and wellness survey included 83.7% of employees described their workday as “mostly sitting,” whereas 41.9% were meeting the physical activity guidelines. In addition, 40% of employees stated they had inadequate social and emotional support (Figure). Using a standardized measurement tool (BRFSS) allows comparison across the United States, state, and best state to set benchmark goals.

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  • 3. Partnership — Elements that relate to efforts designed to integrate with multiple stakeholders including individual workers, employees as a population (representation), organized labor, community organizations, vendor companies, and other internal partners.

Using a grassroots approach outlined by the health engagement director, a Healthy Change process was put in place to allow funds to reach down to the level of directly impacting the health/wellness of specific schools/departments on campus. A specific amount of funds, based on the number of employees, was allotted to each school/department. An anonymous survey listing available programs and environmental changes was sent to all employees to get their feedback, buy-in, and produce relevant program options. The survey also sought out wellness advocates to help spread the word of the new initiative. Employees commented that time was one barrier that prevented them from engaging in their own personal wellness. Therefore, the targeted programs and services were delivered to the employees in their workspace.

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Personal Story/Data

The survey results showed that employees in the Physical Plant, which included the Heat Plant, were interested in finding other modes of transportation, instead of gators and other small gas-powered vehicles, to do their jobs. Healthy IU partnered with multiple stakeholders including the CFO, human resources officer, union employees, management, outdoor recreation, and a local bicycle company to buy retrofitted mountain bikes as a pilot program. Asking employees what they needed, letting them try using the bikes for 6 months, then further retrofitting the bikes, generated buy-in and feasibility. As a result, more bikes have been purchased tomeet the needs of the employees.

  • 4. Comprehensiveness — Elements that, taken together, meet the definition of a comprehensive program (Healthy People 2010) and include health education, supportive physical and social environments, integration of the worksite program into the organization’s structure, linkage to related programs, and worksite screening programs.

A voluntary incentive-based health screening program was rolled out first. The following year, employee input at town hall meetings resulted in the Healthy Change Fund initiative. Employees told management that they wanted a program that provided resources and decision making at the local level, encouraged peer and midmanagement support, delivered products/services that met the specific needs of employees where they work, and offered support for making positive lifestyle choices. Healthy Change funds were allocated to each department to support wellness initiatives at the grassroots level using internal resources where appropriate. Funds for wellness initiatives at the local (departmental or campus) level were made available to provide awareness and education on health and well-being topics. Also highlighted were available resources for employees on campus and in the community. Finally, the program assisted in creating an environment where the healthy choice was made easier. For example, stairwell improvements, signs encouraging taking the stairs, marked walking routes, and refillable water stations were targeted to be implemented to improve physical activity outcomes. In the third year, student wellness interns/coaches were added into the academic curriculum for future sustainability outcome analysis.

  • 5. Implementation — Elements that ensure a planned, coordinated, and fully executed implementation of health management programs, including ongoing monitoring and designated staff with clearly delineated accountabilities.

The initial Healthy Change Fund survey was coordinated with department directors through the wellness advocates. An anonymous survey was emailed to all employees, who then provided input and comments as to environmental changes and educational sessions they were interested in. After Healthy Change Fund survey results were analyzed and presented to the department wellness advocates, two avenues of Healthy Change initiatives, environmental and educational, were explored simultaneously.

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Personal Story/Data

One department supervisor began offering physical activities with incentives to enhance her own employee’s physical activity throughout the workday. This employee was featured in a campus-wide newsletter (3). An employee within this campus building stated: “I now walk four mornings a week before work, and I walk at noon instead of sitting at my desk surfing the Web. Plus I walk a lot more on the weekends, always getting my 10,000+ steps in. I am more concerned about what I am eating now. I still need to do better here, but at least I amthinking about what I put in mymouth. I’d also like tomention, I did NOT want to ‘make any new friends,’ I just wanted to do the program by myself and see how I would do. However, Imet a wonderful person and we have become great friends in such a short amount of time. It makes a huge difference walking with someone; we keep each other going, and almost all of our walking, we do together; just an added bonus of the program that I was not expecting at all!”

Environmental changes, such as installing blood pressure machines, refillable water stations, and opening indoor walking routes, were initiated. A Healthy Change Fund Intern coordinated professional facilitators to bring “learn over lunch” educationals centered on physical activity, nutrition, and stress reduction into the workplace. The series of educationals were delivered during a 6-week period, 1 hour per week. A post-learn over lunch evaluation was sent to all participants. They were asked what lifestyle changes they made as a result and what suggestions they had.

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Personal Story/Data

Sample Healthy Change Analysis:

101 Responses: 38% response rate

83% are not currently participating in any on-campus PA/wellness programs

Lunchtime is the best (37%), slightly better than after work (31%)

Wednesdays (23%) and Tuesdays (20%) are the best days (21% said any day works)

Recommended Learn Over Lunch Sessions:

Session 1: Physical Activity That FitsMy Time, Budget, and Personality: 79%

Session 2: Nutrition: Getting It Just Right: 66%

Session 3: Functional Workstation Workouts: 56%

Session 4: Ergonomic Education: 64%

Session 5: A Taste of Chair Yoga: 58%

Session 6: Work Life Balance: 56%

Environmental Changes:

Marked Walking Routes: 58%

Refillable Water Stations: 52%

Blood Pressure Machines: 47%

  • 6. Engagement — Elements that promote respect throughout the organization, build trust, facilitate program co-ownership through participatory principles, ensure worker representation in decision-making processes, provide meaningful incentives that leverage intrinsic motivation and fit the company culture, and create a workplace environment in which health management programs thrive.

The grassroots focus of the Healthy Change process engaged employees throughout the organization and slowly built back the trust that was lost after the first wellness initiative failed. Before the departmental Healthy Change survey (see Implementation) was sent to all employees, several meetings took place with key members involved in specific departments/schools. From the beginning, the Healthy Change process ensured that the employees were involved in making the decision on programs, how funds were distributed, and environmental changes, and they actively provided feedback on ideas for programming. Most Healthy Change programs began with a physical activity focus through on-site learn over lunch educationals. During these educationals, employees were given incentives including pedometers, cookbooks, stretch bands, workstation movement cards, and activity trackers (including Fitbit Flex and Jawbone Ups). Engaging employees for longer than 6 weeks is vital to creating intrinsic behavior change. Student coaches, enrolled in physical activity degree programs, were paired with employees after participation in learn over lunch educationals to enhance program sustainability.

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Personal Story/Data

Employee quote: “I found the learn over lunch sessions to be absolutely wonderful, and I still can’t believe that my employer would set this up as a tool for me. Atmy previous job, I stood andwalked all day, sometimes carryingmoderate weight. The job I have now is better for the mind and soul and a lot calmer, but all I do isSIT.Whichmeans all Iwant to do is SIT.Which alsomeans that although I eat far less now, I have still gained 25 lbs. Thanks to this wellness initiative, I think I am NOW well onmyway tomaking a lifestyle change that will allowme to loseweight and be healthy for a lifetime. THANK YOU!”

  • 7. Communications — Elements that indicate the presence of a formal communication strategy that includes a branding approach for program visibility, ongoing communications using multiple delivery channels, and targeted and tailored messaging designed to reach specific subgroups.

Initially, a Web site, semiannual newsletter, branded water bottles, pedometers, and handouts were used to raise awareness and increase program visibility. Post-Healthy Change delivery, communication continued with wellness advocates to coordinate walking challenges, piloting activity trackers, and setting up student one-on-one health coaching. Recently, a full-time communication specialist was hired to run the Web site and produce targeted and tailored communication messages to reach employees at all stages of change. Using wellness advocates at the grassroots level to communicate upcoming programs and services was effective but still needs to be developed further. The newly hired full-time communication specialist oversees the wellness advocates and the messaging of the initiative.

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Personal Story/Data

The communication specialist’s first undertaking was to create a unified visual and written identity that represented the intention of the program while creating a communication plan that could be implemented consistently across all campuses. A midrange goal of the communication specialist was to establish a wellness ambassador program that would be a crucial grassroots component of effective communications where peer ambassadors would share wellness information with their workplace and provide a conduit for feedback concerning employee needs.

  • 8. Data driven — Elements that represent the importance of informed decision making and providing guidance through ongoing measurement, evaluation, reporting, and analytics. Data need to be shared appropriately with other vendors for program integration purposes as well as to address comprehensive reporting needs.
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Personal Story/Data

Survey Question: When you are at work, which of the following best describes your work? (%who stated mostly sitting)

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Student coaches did not impact sitting time; however, what was learned was that policies in place (informal and formal) did not allow for employees to move much at work. Even with a physical activity/coach coming to them on-site, employees stated in the postsurvey that they were worried their supervisors did not perceive them as hard workers or they simply could not leave their desk because they had to answer a phone. Sallis et al. (9) would agree that environmental changes in how we work would offer more physical activity/movement opportunities while at work. It is not often the responsibility of the employee to change the work environment; it may be policy at the administrative level that requires consideration for change to occur.

As noted in the Relevance section, a system-wide BRFSS-driven workplace wellness survey was administered to all employees. The survey was used as a benchmark on which to compare interventions and see if behavior change could be evaluated. All subsequent program surveys done at the campus level included questions from the “big” survey. Of particular interest to program development was the issue of sitting time. The big survey showed that 85.5% of employees spent their workday sitting. Based on the data, student coaches were directed to work with a small group of employees with the goal of increasing their movement at work and decreasing their sitting time. Students went to the workplace and walked/moved with clients one to two times per week.

  • 9. Compliance — Elements that ensure health management programs meet regulatory requirements and safeguard individual-level data.

Employees and students working within the employee campus wellness initiative were HIPAA compliant. Employee data were deidentified, and the larger survey was taken through the institutional review board process. In addition, all incentives were tax compliant and met university guidelines. Employees receiving activity tracker incentives signed informed consent forms.

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Personal Story/Data

One of the wellness advocates who participated in an onsite learn over lunch series was working within the financial management area of the university. Her responsibility was to be sure that the university remained compliant with IRS/university rules when employees were given incentives. As a result, this advocate wrote the informed consent information given to employees who received the activity tracker incentive. Having a wellness advocate with these talents helped the compliance and regulation process of the program overall.

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CONCLUSIONS

It is clear that there is a need to visit best practices for employees in the workplace wellness setting so we find out what their needs are and use research-based best practices to try to improve and evaluate current practices. Our prospective analysis connecting the nine-step framework outlined by Pronk (7) with an actual overall workplace wellness initiative demonstrates that small purposeful steps add up and make it easier to advance a wellness program in the right direction. It is interesting that the current health engagement program at this large Midwestern university has increased in both employees and funding based on some of the successes. Many wellness programs do not have this type of success after initial implementation.

Some are even eliminated because of a perception of lack of outcomes. In year 2 of the new worksite wellness program, the university saw a 15% improvement in risk reduction, 100% of employees would recommend the Healthy Change programs to others, and more than 65% of wellness program participants made a positive lifestyle change. We recommend the use of best practices for building sustainable worksite wellness initiatives. If done correctly, Baicker et al. (1) note that workplace wellness programs can generate a return on investment across time. Most importantly, workplace wellness programs can enhance employee morale and enjoyment of their work and lives.

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BRIDGING THE GAP

Professionals have debated best practices for worksite wellness. An example of a workplace health promotion start-up program that uses a best practices model is needed to understand the application of theory to practice. This article uses the nine best practice dimensions outlined in a previous ACSM’s Health & Fitness Journal® article, employee stories, and data outcomes to help bring theory to practice.

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References

1. Baicker K, Cutler D, Song Z. Workplace wellness programs can generate savings. Health Affairs. 2010; 29 (2): 1–8.
2. Behavioral Risk Factor Surveillance System (BRFSS) [Internet]. Atlanta (GA): Center for Disease Control; [cited 2014 May 27]. Available from: http://www.cdc.gov/brfss.
3. Inside IU Bloomington [Internet]. Poplars walking group encourages friendly competition. Bloomington (IN): [cited 2014 Aug. 2]. Available from: http://inside.iub.edu/features/stories/2014-05-29-iniub-story-walking-poplars.shtml.
    4. IU Workplace Health and Wellness Survey Web Site [Internet]. Indianapolis (IN): Indiana University Fairbanks School of Public Health; [cited 2014 May 27]. Available from: http://www.pbhealth.iupui.edu/index.php/research/bhealthy/results/.
    5. New Committee to Promote Greater Workplace Health and Wellness at IU [Internet]. Bloomington (IN): IU Newsroom [cited 2014 Aug. 2] Available from: http://news.iu.edu/releases/iu/university-wide/2013/10/wellness-steering-committee.shtml.
      6. Mattke S, Hangsheng L, Caloyeras JP, et al Workplace wellness programs study. RAND Health [Internet]. 2013 [cited 2014 May 16] Available from: http://www.rand.org/content/dam/rand/pubs/research_reports/RR200/RR254/RAND_RR254.sum.pdf.
      7. Pronk N. Best practice design principles of worksite health and wellness programs. ACSM Health Fitness J. 2014; 18 (1): 42–6.
      8. Pronk N. Primary prevention and health promotion at the workplace: making things visible. ACSM Health Fitness J. 2014; 8 (3): 38–9.
      9. Sallis JF, Carlson JA, Mignano AM. Trends in presentations of environmental and policy studies related to physical activity, nutrition, and obesity at society of behavioral medicine, 1995–2010: a commentary to accompany the active living research supplement to annals of behavioral medicine. Ann Behav Med. 2014; (45 Suppl.): S14–7.
        10. U.S. Department of Health & Human Services Web site [Internet]. Washington (DC): Affordable Care Act; [cited 2014 May 27]. Available from: http://www.hhs.gov/healthcare/rights/law.
        11. Wall JK. Employee ire forces IU to pull wellness survey. Indiana Business Journal [Internet]. 2010 [cited 2014 May 27]. Available from: http://www.ibj.com/employee-ire-forces-iu-to-backtrack-on-wellness/PARAMS/article/23052.
        Keywords:

        Worksite Wellness; Best Practices; Physical Activity; Case Study

        © 2015 American College of Sports Medicine.